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Blue Medicare Essential (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Essential (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Essential (HMO) in 2026, please refer to our full plan details page.
Blue Medicare Essential (HMO) is a HMO plan offered by CuraCor Solutions Corp. available for enrollment in 2025 to people living in Select North Carolina Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Blue Medicare Essential (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Medicare Essential (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Blue Medicare Essential (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $42.50. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue Medicare Essential (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs and Tier 6 select care drugs, you pay no copay when utilizing preferred pharmacies or preferred mail-order services. Tier 2 generic medications also feature no copay through preferred mail order, or a low $4 copay for a one-month supply at a preferred pharmacy. Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs require a 25% coinsurance regardless of whether you use a preferred or standard pharmacy. Standard pharmacy costs are higher, with copays ranging from $15 to $45 for Tier 1 and $20 to $60 for Tier 2 medications. Choosing preferred network pharmacies and mail-order options provides the most cost-effective path for filling prescriptions under this plan.
Additional Benefits
The Blue Medicare Essential (HMO) plan offers predictable costs with no coinsurance for many core medical services, including inpatient hospital stays, outpatient care, and doctor visits. Patients pay a $5 copay for primary care visits, a $45 copay for specialists, and no copay for routine preventive services and home health care. Emergency room visits require a $115 copay, which is waived if admitted, while urgent care visits carry a $40 copay. For supplemental care, the plan features no copay for routine eye exams, glasses, and select preventive dental services, though hearing aids require copays ranging from $499 to $999. Diagnostic lab services also come with no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Blue Medicare Essential (HMO) partially covers inpatient hospital services with no coinsurance and required prior authorization. Acute stays require a $407 daily copay for days 1-6 (no copay for days 7 and beyond, including unlimited additional days), while psychiatric stays require a $407 daily copay for days 1-5 (no copay for days 6-90); upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Medicare Essential (HMO) covers outpatient services with no coinsurance, featuring a $0 to $335 copay for outpatient hospital services and a $335 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Medicare Essential (HMO) plan with a $40 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue Medicare Essential (HMO) covers Medicare-covered ground and air ambulance services with a $275 copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Blue Medicare Essential (HMO) covers emergency services with a $115 copay (waived if admitted within 48 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $100,000 maximum, with copays of $115, $40, and $275, respectively.
Primary Care See details
Blue Medicare Essential (HMO) offers primary care physician services for a $5 copay and specialist visits for a $45 copay, both with no coinsurance. Physical and occupational therapy services carry a $25 copay, mental health sessions are a $40 copay, and telehealth options range from no copay to $45 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services under the Blue Medicare Essential (HMO) plan are covered with no copayments and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. Additional preventive benefits are partially covered, offering fitness programs, caregiver support, and personal emergency response systems with no copay and no coinsurance, while excluding health education, weight management, and in-home safety assessments.
Hearing Services See details
Blue Medicare Essential (HMO) partially covers hearing services with no deductible or coinsurance, offering routine exams and fitting evaluations for no copay, and Medicare-covered exams for a $20 copay. Prescription hearing aids are covered up to two per year with copays ranging from $499 to $999 and no coinsurance, though OTC, inner-ear, outer-ear, and over-the-ear models are not covered.
Vision Services See details
Blue Medicare Essential (HMO) covers routine eye exams with no copay and no coinsurance up to one yearly visit with a $100 maximum, while contact lens exams require a $25 copay and no coinsurance. Eyeglasses, frames, and lenses are covered with no copay and no coinsurance, whereas contact lenses have no copay and a 20% coinsurance, with no deductibles applying to any of these vision services.
Dental Services See details
Blue Medicare Essential (HMO) offers partially covered dental services, featuring Medicare-covered dental for a $45 copay and no coinsurance, and select preventive and comprehensive services with no copay and no coinsurance. Non-covered services include fluoride, restorative services, endodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Medicare Essential (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Blue Medicare Essential (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Essential (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and a 20% coinsurance (0% to 20% coinsurance for diabetic supplies). Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Medicare Essential (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services have no coinsurance, featuring no copay for lab services and a copay of $0 to $25 for procedures, while radiological services carry a minimum 20% coinsurance and no copay for outpatient X-rays, diagnostic, and therapeutic services.
Home Health Services See details
Home Health Services are covered by Blue Medicare Essential (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Blue Medicare Essential (HMO) with no copay and no coinsurance, meaning some services are covered. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Blue Medicare Essential (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Blue Medicare Essential (HMO) partially covers other services, offering chronic illness meal benefits and over-the-counter nicotine replacement therapy with no copay and no coinsurance. Acupuncture is not covered, and the over-the-counter benefit is limited strictly to nicotine replacement therapy.
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